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Book IMq,^ 

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Latest edition 1918. 



Please Preserve for Future Reference 



RULES 



OF THE 



STATE BOARD OF HEALTH 



RELATING TO THE SANITARY CARE OF 

SCHOOLS 



These rules were officially adopted by the State Board of Health on 
January 29, 1913, and published in the official state paper on 
May 30, 1913. Under the provisions of section 1408, Wiscon- 
sin Statutes, these rules liave the full force of law. 

Rule 17. Attendance at School, when Prohibited. All teachers, 
school authorities and health officers having jurisdiction shall not 
permit the attendance in any private, parochial or public school of 
any pupil aflBiicted with a severe cough, a severe cold, itch, lice or 
other vermin, or any contagious skin disease, or who Is filthy in body 
or clothing, or who has anyof the following dangerous, contagious or 
Infectious diseases to wit: Diphtheria, smallpox, scarlet fever, 
measles, whooping cough, chicken pox, mumps, pulmonary tubercu- 
losis, Asiatic cholera, (cholerine), yellow fever, typhus fever, bubonic 
plague, cerebrospinal meningitis or acute anterior poliomyelitis. The 
teachers in all schools shall, without delay, send home any pupil who 
is obviously sick even if the ailment is unknown, and said teacher 
shall inform the parents or guardians of said pupil and also the local 
health officer as speedily as possible, and said health officer shall ex- 
amine into the case and take such action as is reasonable and neces- 
sary for the benefit of the pupils and to prevent the spread of in- 
fection. 

Rule 18. Duty of Parents. Parents, guardians or other persons 
having control of any child who is sick in any way, or who is afflicted 
with any disease listed in Rule 17, shall not permit said child to 



attend any public, private or parochial school or to be present in any 
public place. 

Rule 19. Duty of Teachers, Etc. School-teachers, pupils or other 
persons shall not be admitted to any public, private or parochial 
school who have come from, or who reside in any house or building 
which harbors or is infested with Asiatic cholera (cholerine), yellow 
fever, smallpox, typhus fever, bubonic plague, diphtheria, (membran- 
• ous croup), scarlet fever (scarlatina), measles, (See exceptions) 
cerebrospinal meningitis or acute antexior poliomyelitis. 

Children who have had measles may attend school. Well children 
in the family who have not had measles may return to school after 
fourteen days from date of last exposure provided they take up their 
residence in another home. Children who have measles are not per- 
mitted to leave the premises, and all childrem other than members of 
the family shall not enter or remain upon the premises while the 
home is placarded. 

Rule 20. Air and Floor Space. The minimum requirements of 
the State Building Code, published by the Industrial Commission, in 
existing buildings and new buildings is 12 sq. ft. of floor space for 
each person in the primary grades, 14 sq. ft. per person in the gram- 
mar grades and 16 sq. ft. per person for all other schoolrooms. All 
class, recitation and study rooms (not including manual training or 
domestic science rooms) shall be at least 12 ft. high in the clear; all 
other rooms shall be at least 8 ft. high in the clear.^ 

The provisions of the State Building Code relative to the ventilation 
of school buildings require that all parts of the building except the 
corridors, passageways and stairways shall be provided with fresh air 
at the rate of at least 1200 cubic feet per person per hour." 

Rule 21. Duty of Health Officers. Local health officers having 
jurisdiction shall dismiss forthwith any schoolroom in which at least 
144 cubic feet of air space is not supplied to each pupil. The school 
authorities shall without delay make provisions for thei pupils in 
accordance with the requirements stated in Rule 20. 

Rule 22. Ventilation. Proper ventilation must be provided in all 
schoolrooms and when ventilation ducts do not exist, or are in- 
adequate, it shall be the duty of the teacher to flood the schoolroom 
with fresh air by opening windows and doors at recess and noontime 
and also whenever the air becomes close and foul. Pupils should be 
given gymnastic exercises during the time the windows are open in 
cold weather. 



1 Note — A local or state building permit must be obtained for all new 
schools both public and parochial. (See building code published by the 
State Industrial Commission.) 

*Note — See Order No. 6305 of the State Building Code on Existing 
Buildings and Orders No. 5611 and 5617 on New Buildings. 



D. Of D. 

DEC 4r'':in8 



— 3 — 

When windows are the only means of ventilation they should be so 
constructed as to admit of ready adjustment both at the top and 
bottom, and some device shall be provided to protect the pupils from 
currents of cold air. The top of the windows shall be as near the 
ceiling as the mechanical construction of the building will allow. 

Rule 23. Heating. It shall be unlawful for any school board, 
board of school directors, board of education, or other school officials 
of Wisconsin, to use a common heating stove for the purpose of heat- 
ing any schoolroom, unless each such stove shall be in part enclosed 
within a shield or jacket made of galvanized iron or other suitable 
material, and of such height and so placed as to protect all pupils 
while seated at their desks from direct rays of heat. 

Rule 24. Lighting. Consult State Building Code issued by the 
Industrial Commission. Refer to order number 5 612. 

Rule 25. Sweeping and Cleaning. All floors must be thoroughly 
swept, or cleaned by a vacuum cleaner each day, either after the close 
of school in the afternoon, or onei hour before the opening of school 
in the morning. Before sweeping is started the floors must be sprin- 
kled with moist sawdust, or other substance so as to prevent the rais- 
ing of dust. [The floors in all schoolrooms and halls should be thor- 
ougly scrubbed with soap and water at least once each month.] 

Rule 26. Drinking Water. All schoolhouses must be supplied 
with pure drinking water. If the drinking water is obtained from 
wells, satisfactory troughs and drains must be provided so as to carry 
away the waste water and prevent the creation of mudholes near the 
opening of the well. When water is not supplied at the pump, from 
water faucets, or from sanitary flowing drinking fountains, covered 
tanks or covered coolers, with free flowing faucets, must be supplied. 
All drinking fountains should be constructed of smooth glass or 
pressed metal. Childrea from the same family may be permitted to 
use one drinking cup. 

Rule 27. Toilets. Water-closets, dry closets and outhouses shall 
be kept clean and sanitary at all times. Water-closets, and dry 
closets when provided, shall be efficient in every particular, and when 
said clT)sets are not provided, then good, fly-tight, well-ventilated out- 
houses for both sexes, separated by closely built fences, shall be 
provided. Good, dry walks shall lead to all outhouses, and closely 
built screens, or shields, shall be built in front of them. Outhouses 
for males shall have urinals arranged with stalls and with conduits 
of galvanized iron, or other impervious material, draining into a 
sewer, vault, or other suitable place. See special Bulletin on Rural 
School Privies issued by the State Board of Health.) 

Rule 28. Health officers shall enforce these rules, and promptly 
enter prosecution for any violation thereof. 



'_4 — 

Penalty for A'iolation. Any person who shall wilfully Tiolate any 
law relating to the public health foi- \\hich violation no other penalty 
is prescribe<l, or any order or regulation of any boaiYl of health, law- 
fully made and duly published, shall be punishetl by imprisonment in 
the county jail not more than three months or by fine not exceeding 
one hundred dollars. 

Basement Schools. The use of basements for school purposes Is 
not recommended. Schoolrooms with floors two feet or more below 
grade, used for seating purposes, should be prohibited. In reicitation 
or classrooms where the floors are below grade the walls and floors 
in such rooms should be made damp proof and especial care exercised 
in heating, lighting and ventilating. 

The State Building Code published by the Industrial Commission 
outlines the provisions to be followed in constructing new school 
buildings. 

Disinfection. Section 14 08c. All schoolhouses, before school 
opens at the beginning of each school term, shall be thoroughly 
cleaned and after the outbreak in such school of any contagious dis- 
ease, shall be thoroughly cleaned and disinfected as provided by the 
State Board of Health In its rules and regulations for the fumigation 
and disinfection of homes, or other buildings. All schoolhouses, 
homes, and other buildings requiring disinfection shall be disinfected 
by or under the direction of the local health officer, and the expenses 
necessarily incurred shall be paid for by the township, incorporated 
village, or city upon the order of the local board of health. 

For fumigating, liberate in the room, by means of a generator, a 40 
per cent solution of formaldehyde using not less than ten ounces of 
formaldehyde for every one thousand cubic feet of air space; or place 
in a large deep vessel six and one-half ounces of permanganate of 
potash to which add one pint of a forty per cent solution of formalde- 
hyde. Use the permanganate and formaldehyde in the proportion 
stated for every thousand cubic feet of air space. Solidified formalde- 
hyde may be used for fumigating if the product has been tested and 
approved by the State Board of Health. 

All rooms to be fumigated must contain plenty of moisture and b» 
heated to a temperature above 7 2 degrees F. 

Several firins have now complied with the rules of the State Board 
of Health governing the pre(>aration and mai'keting of solidified 
formaldehyde and their |)roducts may now be used for fumigation. 
Do not use any i>reparation of solidified formaldehyde for fumigating 
purposes unless the same has been tested out and approve<l by the 
State BoaiHl of Health. 

Wheal the material for fumigating is placed in the room all open- 
ings should be closed or covered with strips of paper saturated with a 
strong disinfecting solution and the room left closed for from four to 



six hours after which all windows and doors should be opened to 
allow the free circulation of air. 

Follow the fumigating with a thorough cleaning of the prem- 
ises, wash all woodwork, doors, floors, casings, etc., with an acid 
solution of bichloride of mercury two drams (one-fourth ounce) to a 
gallon of water, or six ounces of carbolic acid to a gallon of water. 
This cleansing process is as important as fumigation. 



— 6 — 



SUGGESTIONS TO SCHOOL BOARDS 



The school board or board of directors of all public and parochial 
schools should see that all school buildings are provided with suitable 
washbowls or basins, soap and individual towels. This will enable 
\the teachers to enforce cleanliness among the pupils after the use of 
the toilets and at other times. This is a very important health 
measure and should not be neglected. 

Cleaning Schoolhouse. The attention of school boards is called to 
section 1408c of the statutes which provides that all schoolhouses, 
before school opens at the beginning of each term, shall be thor- 
oughly cleaned, and after the outbreak in such school of any con- 
tagious disease, shall be thoroughly cleaned and disinfected as pro- 
vided for by the State Board of Health in its rules and regulations for 
the fumigation and disinfection of homes and other buildings. This 
is a very necessary and important measure for the prevention of 
disease and should receive your careful consideration. 

Water Supply. Have you as members of the school board of your 
district given the water supply of your school the careful considera- 
tion that it deserves? All plank covers to wells should be replaced 
by a cement cover made water-tight. The ground should be graded 
away from the well in all directions, and no surface water or mud- 
hole should be allowed to remain near the well. Protect your school 
wells carefully from all surface drainage. All school wells that have 
not been used during the vacation months should be pumped out 
sufficient to remove the stagnant water before school opens* If 
drinking water is not available on the school premises and the water 
is carried any great distance covered pails should be provided. 

Whenever any school official has reason to believe that the school 
well or water supply of any public or parochial school is contam- 
inated or unfit for drinking purposes, he should notify the local 
health officer at once and request him to write to the State Hygienic 
Laboratory for sterile containers and directions for collecting the 
water. Water sent in for analysis by local health officers will be 
analyzed free of charge. The local school board will be required to 
prepay the express charges upon the water shipped to the laboratory. 

Waste Paper Baskets. All schoolrooms should be provided with a 
wastebasket for the reception of waste paper, etc., and the children 
encouraged by the teachers in using same. 



— 7 — 



SCHOOL TOILETS 

Toilets. Chapter 56, Section 1407a — 6, of the statutes, provides 
in part: 

"The State Board of Health shall have supervision of the health 
and life of the citizens of the state and possess all powers necessary 
to fulfill the duties prescribed in the statutes and to bring action in 
the courts for the enforcement of health laws and health rules." 

By subsections 2 and 3, the board is given the power to regulate 
and prescribe) by means of rules and regulations the character and 
location of plumbing, drainage, water supply, disposal of sewage, 
garbage or other waste material, and to prosecute violations of such 
rules and regulations of the State Board of Health. 

Meimbers of school boards violating any rule or regulation of the 
State Board of Health are subject to a fine of from ten to one hun- 
dred dollars. 

All toilets or closets must be provided with suitable toilet paper. 
Teachers should see that the school board furnishes such toilet pa- 
per for their school. 

Over seventy-five per cent of the outdoor toilets or water-closets 
upon school property are found upon inspection to be in an insani- 
tary and unclean condition. There is no excuse for such conditions. 
One gallon of paint applied to the seats and floors will prevent the 
wood from absorbing obnoxious substances and make them much 
easier to keep clean. See that this improvement is made in your 
district at once, then have the closets scrubbed often enough to keep^ 
them clean. You will find the teachers and pupils more than willing 
to keep the premises in a sanitary condition if you will show a little 
pride in their appearance yourselves. 

Teachers should be instructed to visit the toilets frequently and 
to prohibit any obscene or indecent writing or print upon walls or 
seats or any part of the closet. The state law, section 4509, of the 
statutes, provides a fine of not to exceed $500 for such offense. 

For further particulars and specific requirements governing the 
design, construction and maintenance of outside privies, see the Wis- 
consin Code for Rural School Privies, issued by the State Board of 
Health in 1918. 



CHEMICAL AND DRY CLOSETS 

The State Board of Health strongly advises against the indis- 
criminate use of chemical closets, chemical closet systems or the so- 
called "dry closet". In districts where public water supply sewage 
or sewer systems are not available, or where an efficient private 
water supply system of the "compressed air storage" or "air pres- 
sure delivery type" or its equivalent can not be reasonably provided 
and maintained, or where the lay of the land and character of the 



soil is such that the effluent from a sewage treatment tank can not 
be successfully disposed of by one of the variously known methods, 
a properly designed, constructed and installed chemical or dry closet 
will be permitted, provided it conforms with the following minimum 
requirements: 



CHEMICAL CLOSETS 

1. That the installation conforms in every respect as to "hous- 
ing", number of toilets required, design, standards of construction, 
materials, ventilation, light, location, maintenance, etc., with the 
minimum standards found in orders or section numbers 5250 — 5265, 
inclusive, of Industrial Commission, Building Code, and State Board 
of Health, Plumbing Code. 

2. That the materials used on the various units, bowl, tanks, seat, 
vents, agitator, dip tube, roof terminal, etc., comprising the 
chemical closet shall be of proper design and construction, and so 
installed that the highest degree of efficiency possible is insured. 

(a) The bowl shall be of vitreous ware and so designed as to 
be easily kept clean and provided with a top vent attachment. 

(b) The dip tube conveyor pipe between the bowl and tank shall 
be free from offsets, not over four feet in length, shorter where prac- 
ticable, and be of copper or other nonabsorbent, indestructible ma- 
terial. 

(c) The joints between bowl and tip tube, and tank and dip tube 
shall be made water-tight. 

(d) The material used in the construction of the tank shall be 
of such quality and weight and so protected that it will serve for 
a period of ten years without replacement. 

(e) The ventilating system shall be of substantial material, ade- 
quate size, and constructed to insure effective ventilation. 

(f ) The tank shall be provided with an efficient method of drain- 
ing or cleaning out contents of the tank. 

(g) The agitator shall be so constructed as to be easily operated, 
(h) That plans and specifications be submitted for approval and 

be sufficiently detailed and cross-sectioned, etc., to enable the depart- 
ment to pass on the various essentials herein outlined. 

Note. Order No. 5008 of the State Building Code requires that 
plans for new buildings be submitted to the Industrial Commission 
for approval. Plans so submitted will be referred by that depart- 
ment to the State Board of Health for approval of toilet require- 
ments. 

3. The phenol coefficient of the chemical used shall be clearly 
stated on the package or container. Full directions for using the 
chemical shall be furnished with each package or container. The 



— 9 — 

chemical solution so used, shall at all times be maintained of such 
a strength as to effectively sterilize the tank contents. 

4. That the installation at all times shall be maintained in a 
sanitary and serviceable condition, and the materials when removed 
from the tank disposed of in such a manner that a nuisance is not 
created. 

5. Before any type of chemical closet is installed in any school 
building the school board of that district or its legal representative 
shall apply to the State Board of Health for permission to install 
such toilet, giving the size and description of the school building and 
other existing conditions effecting the installation, also the source 
and type of water supply, the character of the soil, the lay of the 
land, and the type of chemical closet to be installed. When the in- 
stallation has been completed the State Board of Health shall be 
notified so that an inspection may be made before the installation is 
accepted by the school board or district. 

6. In giving permission for the installation of chemical toilets 
the State Board of Health does not assume responsibility for the 
satisfactory operation of the installation, in whole or in part, but 
reserves the right to order its removal should conditions dangerous 
to health or otherwise objectionable arise therefrom. 



DRY CLOSETS 

1. That the installation conform in every respect as to "hous- 
ing", number of toilets required, design, standards of construction, 
materials, ventilation, light, location, maintenance, etc., with the 
minimum standards found in orders or section numbers 5250 to 
5265, inclusive, in Industrial Commission, State Building Code, and 
State Board of Health, Plumbing Code. 

2. That the materials and construction of the various units com- 
prising the dry closet system be of proper design, and so installed 
that the highest degree of efficiency possible is insured. 

3. That the vault and conveyors be of proper design and water- 
tight construction. 

4. That the cross section vault area be at least 50% larger than 
the combined foul air conveying flues connected therewith, and that 
the open space below the grates be at least from 8 to 10 inches in 
height. 

5. That the foul air duct, stack, and heater be of adequate capa- 
city and that a fire be maintained either in the stack heater or heat- 
ing system at all times so as to insure proper ventilation. 

6. That the foul air duct, or ducts, be provided with a damper 
of efficient design and conveniently located, and that the foul air 
removal system be so constructed as to exclude, under all proper con- 
ditions involving maintenance, obnoxious odors from any part of 



— 10 — 

the building and so that it will comply with the fire protection re- 
quirements of the state building code. 

7. That the chimney containing the stack heater be extended to a 
height of from 8 to 10 feet above the highest part of the building 
so as to insure effective ventilation. 

8. The closet hopper shall be so designed and of such material 
that it can be kept clean and be provided with an approved seat. 

9. That plans and specifications be submitted for approval and 
be sufl^ciently detailed and cross-sectioned, etc., to enable the de- 
partment to pass on the various essentials herein outlined. 

Note. Order No. 5 008 of the State Building Code requires that 
plans for new buildings be submitted to the Industrial Commission 
for approval. Plans so submitted will be referred by that depart- 
ment to the State Board of Health for approval of toilet require- 
ments. 

10. That the vault be burned out and cleaned and disinfected 
whenever necessary. 

11. That the installation at all times shall be maintained in a 
sanitary and serviceable condition, and the material, when removed, 
from the vault be disposed of in such a manner that a nuisance is 
not created. 

12. Before any type of dry closet is installed in any school build- 
ing the school board of that district or its legal representative shall 
apply to the State Board of Health for permission to install such 
toilet, giving the size and description of the building, the source and 
type of water supply, the lay of the land and character of the soil, 
also the type of closet to be installed. When the installation has 
been completed the State Board of Health shall be notified so that 
an inspection may be made before the installation is accepted by 
the school board or district. 

13. Under the law the State Board of Health reserves the right 
to reject any and all types of closets and may prohibit the installa- 
tion of any such closet w^hen in its judgment such prohibition is wise. 

14. In giving permission to install dry closets the State Board 
of Health does not assume responsibility for the satisfactory oper- 
ation of the installation, in whole or in part, and reserves the right 
to order its removal should conditions dangerous to health or other- 
wise objectionable arise therefrom. 

The attention of the school board and others interested is directed 
to modern conveniences, such as running drinking water, washing 
facilities and water flushed toilets which can, in most cases, be in- 
stalled at a reasonable cost considering the protection and comforts 
thus afforded. The State Board of Health will render you assistance 
in making a full investigation of all factors to be considered in de- 
termining which system of toilets will serve your particular condi- 
tion best, and thus protect the lives and welfare of your children 
and those employed in your schools. 



11 — 



INSTRUCTIONS TO TEACHERS 



It is obvious to any one at all familiar with the prevention of com- 
municable diseases that the teacher may be of great assistance in en- 
forcing preventive measures. Teachers come in close contact with 
children and under present conditions the schools are often ideal 
places for the transmission of communicable diseases. The teach- 
ers, therefore, should be constantly alert to detect at once the pres- 
ence of any communicable disease among the children under this 
supervision. By constant watchfulness, a great deal of sickness and 
a, large number of deaths due to communicable diseases contracted 
in the schools will be avoided. "Eternal vigilance on the part of 
the teachers is the price which must be paid in safeguarding the 
liealth of school children." 

Not only should teachers use every precaution to prevent the intro- 
duction or spread of preventable diseases in the schools, but they 
should also see that the schoolroom is properly ventilated, that a 
sufficient supply of fresh drinking water is provided and that the 
children are educated in habits of personal cleanliness. This in- 
cludes the care of the teeth, the washing of the face and hands and 
other matters that are of more vital importance to the well-being 
of the pupils than the reciting of lessons. Teachers should realize 
that their duty is not complete when only the daily lessons are 
learned. 

The following is a brief outline of suggestions to teachers which 
may be helpful. 

1. Teachers should remember that infection enters and leaves 
the body in the secretions of the mouth, nose, throat, intestines and 
through the skin. 

2. Sunshine, pure air, good food, exercise and cleanliness are 
the best aids to good health. 

3. The exchange or borrowing of all articles which might be used 
in common, such as pencils, penholders and slates, which are liable 
to be soiled with secretions of the eye, nose or mouth should be pro- 
hibited. 

4. Cleanliness in and after each use of the toilet should be in- 
sisted upon. 

5. When diphtheria or scarlet fever is present in the community, 
all children with sore throats or discharging noses or ears should 
be excluded from school, and no child returning to school, after an 



— 12 — 

attack, with discharging nose or ears or without a permit from the 
health officer should be allowed to remain. 

6. When measles is present in the community, all children show- 
ing symptoms of a marked cold in the head should be immediately 
excluded from school. 

7. All children with whooping cough should be kept at home. 

Duty of Teachers. Section 1408a. Upon the appearance of any 
dangerous communicable disease in any school district, it shall be 
the duty of the health officer of the township, incorporated village, 
or city where the schoolhouse is located to notify at once, in writing, 
the principal or teacher of such school, giving the names of all fam- 
ilies where the disease exists. If the rules of the State Board of 
Health provide for the exclusion from school df teachers, or pupils 
from homes where such disease exists, the health officer shall re- 
quest the principal of the school to exclude from school attendance 
all such persons until a written order signed by the health officer 
permitting attendance at school is presented. 

Whenever the principal or teacher of the school has been notified 
of the prevalence of a dangerous communicable disease in the school 
district, or whenever the principal or teacher of the school knows or 
suspects that a dangerous communicable disease is present in the 
school district, it shall be the duty of such principal to at once 
notify the health officer of the town, village, or city where the school- 
house is located, of such absence from school on account of sickness. 
The health officer must then investigate all such cases, to determine 
whether or not a dangerous communicable disease is present in such 
family. 

E?xclusion from School. Section 1408b. Parents, guardians, or 
persons having custody of any child or children, shall not permit 
such child or children, if afflicted with a dangerous communicable 
disease, or if they have been exposed to a dangerous communicable 
disease, except tuberculosis and typhoid fever, to attend any school. 



13 — 



CHARACTERISTICS OF THE COMMUNICABLE 

DISEASES 



Note. The period of incubation is the time which elapses after 
the reception of the infection until the first symptoms occur. 

Tuberculosis. Tuberculosis, or consumption, is a very common 
and very fatal disease which is nearly always contracted from one 
who has the disease, or from food and drink in which tubercular 
germs are present. Every case of tuberculosis is the result of in-' 
fection, but there are many contributory causes, such as living and 
sleeping in unventilated rooms, insufficient or unsuitable food, etc. 
A cold which settles on the lungs and remains for weeks or months 
should arouse suspicion, and it is always advisable in such cases to 
consult a reliable physician. A child who coughs daily should see 
the family physician for an examination, especially if the cheeks 
become flushed in the afternoon and fatigue is easily induced. The 
pale, anaemic child, with a narrow chest, is a likely subject for tuber- 
culosis. Good food, pure air, sunshine and plenty of outdoor exer- 
cise are the enemies of tuberculosis. Children should be taught not 
to sleep in a room with anyone who has tuberculosis. 

Scarlet fever, (scarlatina, scarlet rash.) Period of incubation two 
to five days. The onset of the symptoms is unusually sudden. The 
rash appears within twenty-four or forty-eight hours after the first 
symptoms (shorter than in measles or smallpox), usually coming out 
first on the neck and chest, afterward extending to the limbs. The 
fever does not abate suddenly, after the appearance of the eruption, 
as in measles and smallpox. Rash consists of a multitude of fine 
red or scarlet points, the color of which is diffused over the whole 
surface. Sore throat is nearly always an early and prominent symp- 
tom. The tongue usually presents a peculiar appearance designated 
as "strawberry tongue." Cases are immediately and dangerously 
infectious and continue so until the completion of the desquama- 
tion, or peeling, which is often quite prolonged. The infection may 
come directly from the patient or be carried upon the person or in 
the clothing of those who have not had the disease. Infected cloth- 
ing, furniture, rooms, etc., may retain their infectious qualities for 
a long time unless very carefully and thoroughly disinfected. After 
10 or 12 years of age there is a rapid diminution of susceptibility 
on the part of the child, to the infection of scarlet fever. (See cir- 
cular on scarlet fever.) 



— 14 — 

Diphtheria. Period of incubation two to seven days, but may be 
longer or shorter. The distinctive feature of the disease is a false 
membrane which invades the mucous membrane, more frequently 
the membrane of the throat. The false membrane appears at first 
as a whitish patch, or there may be several such spots, which may 
gradually or rapidly increase in size and coalesce. The condition 
and appearance of the false membrane as first discovered may remain 
stationary for a while, or gradually disappear. Occasionally in 
cases of diphtheria the false membrane is in the nose passages or 
in other localities where it is not to be seen. When diphtheria is 
prevalent it is safer to regard all cases of sore throat as diphtheria, 
and to require a reasonable amount of care until they are known to 
be nondiphtheretic and noninfectious. Diphtheretic sore throat is 
diphtheria. 

The diplitheretic infection is much more dangerous to children 
than to adults. Adults, or even children who have been exposed to 
the infection very often have the germs of diphtheria growing and 
multiplying in their throats and are, therefore, dangerous infection 
carriers even when they have no sore throats. Persons who have 
had diphtheria occasionally carry the infection in a dangerous form 
in their throats after complete recovery has apparently occurred. 
When a person who has had diphtlieria ceases to be infectious that 
fact should be determined by examinations made in the State Labo- 
ratory of Hygiene. It is sometimes difficult for the most experienced 
physician to determine whether a case may or may not be diphtheria 
and the laboratory should be used to determine the question. Anti- 
toxin should be used early in all cases. (See circular on diph- 
theria. ) 

Measles. Period of incubation eight days on an average, or 
twelve days to the appearance of the rash. Eruption prec-eded for 
about four days by catarrhal symptoms, like those of a severe cold 
in the head. Fever falls rapidly after the eruption is fully out. 
Rash usually begins on the face as slightly raised red spots which 
form crescent shaped groups, coalescing into patches of irregular 
outline. Eruption more distinctly "blotchy" than in scarlet fever 
and a duller red instead of scarlet. Measles is infectious in its 
earliest stages before the rash has appeared. Children can return 
to school after complete recovery. 

Whooping cough. May be communicated either directly from 
the patient or through the medium of infected clothing, etc. Pe- 
riod of incubation about six days. The peculiar cough is usually 
characterized by a series of quick, short, forcible expirations with 
flushed face, then recovery of breath with a long shrill whoop, or 
a succession of such. The "whooping" begins in the second week 
of the disease; sometimes later. The earlier symptoms are like 
those of a common cold with a cough of ordinary character. The 
infection lasts. from six to eight weeks after the disease is declared. 



— 15 — 

Typhoid fever. Period of incubation fourteen to twenty-one days, 
l)ut may be shorter, especially in cases with a severe and rapid 
"Course. The natural duration of the disease is three or four weeks, 
"hut severe cases may end fatally even in ten or twelve days, or mild 
cases naay recover in two or three weeks. The infection is given 
■off by the patient principally in the dejections, both solid and liquid, 
therefore, the proper disinfection and disposition of these will go 
far in preventing other persons taking the disease. 

Typhoid fever is very frequently spread by contact infection, for 
instance, by the hands of the attendant who, at the same time, with- 
out washing and disinfecting her hands carefully, prepares the meals 
of other persons; by cups or spoons or other articles which have 
been used in the sick room and have not been disinfected before sub- 
•sequent use, etc. Infected water and infected milk are frequent 
Agencies for conveying typhoid infection. Flies also carry the 
typhoid germs. Antityphoid vaccine will prevent typhoid fever. 
This material is distributed free of charge by the State Laboratory 
of Hygiene to all physicians of the state. (See circular on typhoid 
fever.) 

Smallpox. Period of incubation ten to fourteen days. The erup- 
tion begins to show as small red spots or specks, dnd then as pimples 
or papules, at first on the face and wrists, gradually passing over 
the body. Sometimes, though rarely, at this stage a diffused rash 
appears. The papules are changed in about twenty-four hours into 
vesicles which, when they are sufficiently developed, show a charac- 
teristic depression in the center, that is, are "umbilicated." The 
contents of the vesicles gradually become yellow, and the eruption 
lias then become pustular. In varioloid the eruption aborts at vari- 
ous stages. Severe pain in the back and headache are some char- 
acteristics of smallpox. There is usually a marked diminution of 
the fever after the eruption is out. Smallpox is intensely infectious, 
but less so in the earlier stages of the eruption. The smallpox pa- 
tient is infectious until the skin is cleared of all crusts and careful 
disinfection is done. 

Vaccination not only lightens smallpox, if one happens to take it, 
l)ut when successfully done, and not too remotely, insures almost 
absolute protection, from taking the disease. 

Ordinarily the schools should not be closed when smallpox is pres- 
ent in the school district. Under the provisions of Chapter 113, Laws 
of 1907, the attendance at school of any and all pupils or teachers 
who have not been successfully vaccinated or who fail to show a 
certificate of recent vaccination is prohibited for a period of twenty- 
five days when smallpox is present in the school district or any part 
thereof. Should new cases of smallpox continue to develop in such 
school district, after the expiration of twenty-five days, the local 
Taoard of health shall, upon the advice and consent of the State Board 
of Health, renew such order for another period of twenty-five days 
or so many days thereof as the State Board of Health may deem 
tnecessary in order to control the epidemic. The local board of 



— 16 — 

health is authorized to provide for the free vaccination of all chil- 
dren in any school district or any part thereof during an epidemic 
of smallpox, the necessary expense incurred to be paid by the town, 
village or city upon the order of the local board of health. 

German measles (Rotheln). This eruptive disease has no rela- 
tion to measles or scarlet fever with which it is sometimes con- 
founded. Its period of incubation is long, two to three weeks. The 
eruption appears earlier than in measles, often within twenty-four 
hours after the first symptoms. The rash fades about the third 
day or earlier and the fever gradually disappears with the rash. 
Desquamation is absent or very slight. The eruption is not so 
"blotchy" as that of measles; sometimes resembles that of scarlet 
fever. Incubation is longer than that of measles and much longer 
than that of scarlet fever. Period of invasion shorter than that of 
measles. Catarrhal symptoms not so severe as in measles. Throat 
symptoms not so marked a feature as in scarlet fever. Patient 
should not return to school until at least two weeks after recovery. 

Croup. Membranous croup is diphtheria of the air passages, and 
the same precautions should be observed as are carried out in ordi- 
nary diphtheria. 

Chicken pox. Period of incubation ten or fourteen days, may be 
shorter or may be prolonged to eighteen or twenty days. Period of 
invasion very short. A disease of childhood. The eruption consists 
of clear watery blisters or vesicles, scattered irregularly over the 
body. The eruption is often the first thing noticed. Premonitory 
symptoms are often overlooked as also are often the small red spots 
preceding the vesicles. The "blisters" reach their full development 
in twenty-four to thirty-six hours; but from the first observation to 
full development the time is often much shorter. Successive crops 
of vesicles and unequal development of them on the same parts of 
the body. With the appearance of the eruption, the fever increases. 
(Compare with smallpox.) 

Children who have any of the following diseases are prohibited 
from attending school 

Asiatic cholera (cholerine), yellow fever, smallpox, typhus fever, 
bubonic plague, diphtheria (membranous croup), scarlet fever (scar- 
latina), measles including rotheln, chicken pox, mumps, pulmonary 
tuberculosis, whooping cough, cerebrospinal meningitis or acute an- 
terior poliomyelitis. 

Children from homes where any of the following diseases exist can- 
not attend school 

Asiatic cholera (cholerine), yellow fever, smallpox, typhus fever, 
bubonic plague, diphtheria (membranous croup), scarlet fever (scar- 
latina), measles, cerebrospinal meningitis or acute anterior polio- 
myelitis. [See rule 19 for exceptions in case of Measles.] 



17 



INSTRUCTIONS FOR PHYSICIANS AND 
OTHER PERSONS REQUIRED TO RE- 
PORT DANGEROUS COMMUNICABLE 
DISEASES 



In case of Diphtheria, Scarlet Fever, Smallpox, Acute Oerehro- 
spiual Meningitis, Acute Anterior Poliomyelitis, Asiatic Cholera, 
Typhus Fever and Bubonic Plague the following minimum require- 
ments must be complied with. 

1. Cases must be reported to the local health oflBcers within 

twenty-four hours. 

2. Quarantine sign required on house in conspicuous place. 

3. Thorough disinfection of infected rooms and contents after 

death or recovery of patient and before quarantine is re- 
moved. 

4. Milk or dairy products from a dairy or farm where disease ex- 

ists can not be sold or used unless the milk is handled, 
milk utensils washed, stock cared for and product trans- 
ported by persons entirely disassociated with the quaran- 
tined family. 



18 



QUARANTINABLE DISEASES AND REGULA- 
TIONS 



For Diphtheria or Membranous Croup. 

1. Quarantine for patient at least fourteen days or until two- 

negative cultures, taken three days apart by a representa- 
tive of the health department, show the absence of diph- 
theria bacilli. 

2. Persons associated with or in the family with the patient must 

be quarantined. Adults in family may be released from 
quarantine after fumigation of clothing and complete an- 
tiseptic bath. 

For Scai'let Fever. 

1. Minimum quarantine twenty-one days, or longer, until des- 
quamation is complete. Adults in family may be disin- 
fected and released, provided they do not return to the 
quarantined home. Children in the household not ill may 
be disinfected and quarantined elsewhere for ten days or 
until the symptoms of scarlet fever develop. Children 
convalescing from scarlet fever can not attend school for 
at least six weeks from the beginning of the disease. Well 
children in same family can not attend school for ten days 
after removal of quarantine. 

For Smallpox. 

1. Quarantine for patient until all crusts or scales have fallen 

off. For exposed persons quarantine for fourteen days^ 
after date of last exposure, unless successfully vaccinated 
and disinfected. Wage earners in family may be vac- 
cinated, disinfected and leave premises. 

2. When smallpox is present in a school district teachers or pu- 

pils who have not been successfully vaccinated or who fail- 
to show a certificate of recent vaccination can not attend 
school for twenty-five days after the appearance of the dis- 
ease. 

For Spinal Meningitis (Acute Cerebro). 

1. Quarantine of patient and attendant and isolation from rest 
of family for at least fourteen days. (Other members of 
family not quarantined.) 



— 19 — 

For Acute Anterior Poliomyelitis (Infantile Paralysis). 

1. Minimum quarantine at least three weeks from beginning of 
the disease. Adults in family may be released from quar- 
antine after disinfection of clothing and complete antiseptic 
bath. All children who have been exposed to the disease 
should be isolated at least fourteen days from the date of 
last exposure. 

For Asiatic Cliolera (Cholerine) and Yellow Fever. 

1. Quarantine for patient until after death or complete recovery. 

Quarantine for exposed persons five days from date of last 
exposure. 

2. Most rigid disinfection of all discharges. 

For Typhus Fever. 

1. For patient quarantine until after complete recovery. For 
exposed persons quarantine for twenty-one days from date 
of last exposure. Since this disease is spread by body lice 
clothing should be removed, burned or disinfected by im- 
mersing in a 1-500 bichloride of mercury solution or by 
boiling. 

For Bubonic Plague. 

1. Quarantine for patient until after death or complete recovery. 

For exposed persons quarantine for eight days from date= 
of last exposure. 

2. Thorough disinfection of all discharges. 



— 20 — 



DISEASES WHICH MUST BE PLACARDED 



Typhoid Fever. 

1. Cases must be reported to the local health officer within twen- 

ty-four hours. 

2. Conspicuous placard on house. 

3. Isolation of patient. No restrictions on other members of 

family. Excreta from patient must be thoroughly disin- 
fected. 

4. Thorough disinfection of infected rooms and contents after 

death or recovery of patient and before placard is removed. 

5. Milk or dairy products from a dairy or farm where disease 

exists can not be sold or used unless the milk is handled, 
milk utensils washed, stock cared for and product trans- 
ported by persons entirely disassociated with the family. 

Measles Including Rubella (Rotheln). 

1. Cases must be reported to local health officer within twenty- 

four hours. 

2. Conspicuous placard on house. 

3. Children who have measles are not permitted to leave the 

premises and any children other than members of the fam- 
ily shall not enter or remain upon the premises while the 
home is placarded. Children who have had measles may 
attend school from the home. Well children in family 
who have not had measles may return to school after four- 
teen days from date of last exposure provided they take up 
their residence in another home. 

4. There are no restrictions on the adult members of the family. 

5. Thorough disinfection of the infected rooms and contents 

after death or recovery of patient and before placard is re- 
moved. 

Whooping Cough. 

1. Cases must be reported to the local health officer within twen- 

ty-four hours. 

2. Conspicuous placard on house. 

3. Isolation of patient until after whooping stage (about six 

weeks). 



— 21 — 

4. Children who have whooping cough are not permitted to leave 

the premises and children other than members of the fam- 
ily shall not enter or remain upon the premises while the 
home is placarded. Well children may go to school. 

5. Thorough disinfection of the infected rooms and contents after 

death or recovery of patient and before placard is removed. 

Cliicken Pox. 

1. Cases must be reported to local health officers within twenty- 

four hours. 

2. Conspicuous placard on house. 

3. Children who have chicken pox can not attend school or leave 

the premises. Children other than members of the family 
shall not enter or remain upon the premises while the home 
is placarded. 

4. Fumigation not required. Well children may go to school. 



22 — 



DISEASES WHICH MUST BE REPORTED BUT 
NOT PLACARDED OR QUARANTINED 



Mumps. 

1. Cases must be reported to local health officer within twenty- 

four hours. 

2. Children who have mumps can not attend school. 

3. This disease is an epidemic affection and is transmitted almost 

exclusively by direct contact from person to person. 

Ei'y.sipelas. 

1. Cases must be reported to the local health officer within twen- 

ty-four hours. 

2. Patients must be isolated from other members of the family. 

3. Disinfection -of materials coming in contact with the erysip- 

elatous areas required. 

TuberculosLs (of any organ). 

1. Cases must be reported to the local health officer within twen- 

ty-four hours. 

2. Teachers or pupils who have pulmonary tuberculosis cannot 

attend school. 

3. Careful instructions regarding the disinfection of sputum, 

proper diet and sleeping facilities should be given. 

4. Every person who has tuberculosis of the lungs or larynx must 

provide a sputum flask or receptacle in which he shall de- 
posit all expectorations while in a public conveyance or 
attending any public place. 

5. Thorough disinfection of infected rooms and contents after 

death or recovery of patient is required by law. 

Trachoma. 

1. All cases must be reported to the local health officer within 

twenty-four hours. 

2. Patient should use individual towel and washbasin. Dis- 

charges from eyes should be collected on cloths or paper 
napkins and burned. Intimate contact with others should 
be prohibited. 



— 23 — 

Ophthalmia Neonatorum. 

1. Cases must be reported to local health officer within twenty- 

four hours. 

2. Discharges from eyes should be collected on cloths or paper 
napkins and burned. 

About one-third of the cases of blindness due to this local cause 
result from this easily preventable disease. 

V^eiiereal Diseases. 

All cases of syphilis and gonorrhea must be reported by the at- 
tending physician. A special form of blank is furnished physicians 
for reporting these cases direct to the State Board of Health. Th6 
patient's name is not required. 

Cost of Disinfection. 

When fumigation is required after the death or recovery of a per- 
son suffering from a dangerous communicable disease the work must 
be done by or under the direction of the local health officer and the 
expenses incurred paid by the township, incorporated village or city 
upon the order of the local board of health. 

Disinfection without fumigation shall be required where a case of 
ophthalmia neonatorum, measles, whooping cough, typhoid fever 
and chicken pox, has occurred. 

Disinfection is defined to be the washing of all woodwork, doors, 
casings and other articles which may be infected, with a proper solu- 
tion of bichloride of mercury, carbolic acid, corrosive sublimate, 
formaldehyde or other approved disinfectant containing the phenol 
coefficient as determined by the Marine Hospital Laboratory. (The 
material used for disinfection can be left at the home by the health 
officer with instructions for properly doing the work.) 

Fumigation is defined to be the liberation in the room of formalde- 
hyde gas in sufficient quantities and under proper conditions to ac- 
complish satisfactory aerial disinfection. This work must always 
be done by the health officer or some competent person employed by 
the board of health for that purpose. 



020 948 950 8 



